Prevalence and characteristics of chronic pain following mastectomy and breast reconstruction: A systematic review and meta-analysis.

PURPOSE: We aimed to investigate chronic pain in mastectomy alone, as well as alloplastic reconstruction and autologous reconstruction following mastectomy. Primary outcome included comparing overall chronic pain prevalence between these breast procedures. Secondary outcomes included describing 1) characteristics and location of chronic pain and 2) chronic pain intensity.

METHODS

MEDLINE, Embase, and Web of Science were searched on December 9, 2024 with no restriction on the date of publication. Titles, abstracts, and full texts screening and data extraction was conducted independently and in duplicate. Inclusion criteria required: 1) mastectomy with or without breast reconstruction for breast cancer or risk reduction, (2) minimum three-month post-operative follow-up, (3) pain in the breast, ipsilateral chest wall, axilla, arm, or donor site after breast surgery. Meta-analyses were carried out using a random-effects model with 95% confidence interval (CI).

RESULTS

Ninety-one studies with 26,132 patients with breast cancer were included in this systematic review. Sixteen different pain scales were used to describe chronic pain. Overall, 85% of studies reported at least one secondary outcome. Fifty-two studies were pooled for meta-analyses. Mean chronic pain prevalence following mastectomy was 41.79% (CI: 33.08, 50.49). Mean chronic pain prevalence was 49.47% (CI: 32.95, 66.00) and 42.81% (CI: -3.55, 89.17) following immediate alloplastic reconstruction and delayed autologous reconstruction, respectively.

CONCLUSION

Chronic pain following mastectomy and reconstruction is prevalent. Therefore, studies that better characterize how timing and type of breast reconstruction affect chronic pain, using validated breast cancer specific pain assessment tools, are warranted.